Chronic medical conditions associated with invasive pneumococcal diseases in inpatients in teaching hospitals in São Paulo city: Estimating antimicrobial susceptibility and serotype-coverage of pneumococcal vaccines

Background: Chronic conditions increase the risk of invasive pneumococcal diseases (IPD). Pneumococcal vaccination remarkably reduced IPD morbimortality in vulnerable populations. In Brazil, pneumococcal vaccines are included in the National Immunization Program (PNI): PCV10 for < 2 years-old, and PPV23 for high risk-patients aged ≥ 2 years and institutionalized ≥ 60 years. PCV13 is available in private clinics and recommended in the PNI for individuals with certain underlying conditions. Methods: A retrospective study was performed using clinical data from all inpatients from five hospitals with IPD from 2016 to 2018 and the corresponding data on serotype and antimicrobial-non-susceptibility of pneumococcus. Vaccine-serotype-coverage was estimated. Patients were classified according to presence of comorbidities: healthy, without comorbidities; at-risk, included immunocompetent persons with specific medical conditions; high-risk, with immunocompromising conditions and others RESULTS: 406 IPD cases were evaluated. Among 324 cases with information on medical conditions, children < 5 years were mostly healthy (55.9%), while presence of comorbidity prevailed in adults ≥ 18 years old (> 82.0%). Presence of ≥1 risk condition was reported in ≥ 34.8% of adults. High-risk conditions were more frequent than at-risk in all age groups. Among high-risk comorbidity (n = 211), cancer (28%), HIV/AIDS (25.7%) and hematological diseases (24.5%) were the most frequent. Among at-risk conditions (n = 89), asthma (16.5%) and diabetes (8.1%) were the most frequent. Among 404 isolates, 42.9% belonged to five serotypes: 19A (14.1%), 3 (8.7%), 6C (7.7%), 4 and 8 (6.2% each); 19A and 6C expressed antimicrobial-non-susceptibility. The vaccine-serotype-coverage was: PCV10, 19.1%, PCV13, 43.8%; PCV15, 47.8%; PCV20, 62.9%; PCV21, 65.8%, and PPV23, 67.3%. Information on hospital outcome was available for 283 patients, of which 28.6% died. Mortality was 54.2% for those with meningitis. Conclusion: Vaccine with expanded valence of serotypes is necessary to offer broad prevention to IPD. The present data contribute to pneumococcal vaccination public health policies for vulnerable patients, mainly those with comorbidity and the elderly. Keywords: Antimicrobial resistance; Chronic diseases; Comorbidity; Invasive pneumococcal diseases; Pneumococcal conjugate vaccine; Pneumococcal serotypes; Pneumococcal vaccine.

Chronic medical conditions associated with invasive pneumococcal diseases in inpatients in teaching hospitals in São Paulo city: Estimating antimicrobial susceptibility and serotype-coverage of pneumococcal vaccines

ABSTRACT Background: Chronic conditions increase the risk of invasive pneumococcal diseases (IPD). Pneumococcal vaccination remarkably reduced IPD morbimortality in vulnerable populations. In Brazil, pneumococcal vaccines are included in the National Immunization Program (PNI): PCV10 for < 2 years-old, and PPV23 for high risk-patients aged ≥ 2 years and institutionalized ≥ 60 years. PCV13 is available in private clinics and recommended in the PNI for individuals with certain underlying conditions. Methods: A retrospective study was performed using clinical data from all inpatients from five hospitals with IPD from 2016 to 2018 and the corresponding data on serotype and antimicrobial-non-susceptibility of pneumococcus. Vaccine-serotype-coverage was estimated. Patients were classified according to presence of comorbidities: healthy, without comorbidities; at-risk, included immunocompetent persons with specific medical conditions; high-risk, with immunocompromising conditions and others Results: 406 IPD cases were evaluated. Among 324 cases with information on medical conditions, children < 5 years were mostly healthy (55.9%), while presence of comorbidity prevailed in adults ≥ 18 years old (> 82.0%). Presence of ≥1 risk condition was reported in ≥ 34.8% of adults. High-risk conditions were more frequent than at-risk in all age groups. Among high-risk comorbidity (n = 211), cancer (28%), HIV/AIDS (25.7%) and hematological diseases (24.5%) were the most frequent. Among at-risk conditions (n = 89), asthma (16.5%) and diabetes (8.1%) were the most frequent. Among 404 isolates, 42.9% belonged to five serotypes: 19A (14.1%), 3 (8.7%), 6C (7.7%), 4 and 8 (6.2% each); 19A and 6C expressed antimicrobial-non-susceptibility. The vaccine-serotype-coverage was: PCV10, 19.1%, PCV13, 43.8%; PCV15, 47.8%; PCV20, 62.9%; PCV21, 65.8%, and PPV23, 67.3%. Information on hospital outcome was available for 283 patients, of which 28.6% died. Mortality was 54.2% for those with meningitis. Conclusion: Vaccine with expanded valence of serotypes is necessary to offer broad prevention to IPD. The present data contribute to pneumococcal vaccination public health policies for vulnerable patients, mainly those with comorbidity and the elderly.

Dietary pattern in women with polycystic ovary syndrome with and without associated non-alcoholic fatty liver disease: A cross-sectional study

Abstract Introduction Women with Polycystic Ovary Syndrome (PCOS) have a higher prevalence of Nonalcoholic Fatty Liver Disease (NAFLD) than the general population. PCOS and NAFLD have common metabolic risk factors, however, the role of diet in NAFLD development is still uncertain in PCOS women. Objective To evaluate and compare the dietary patterns and nutritional intake in patients with PCOS with and without NAFLD. Method Cross-sectional study that included patients with PCOS diagnosed according to Rotterdam criteria. All participants were submitted to abdominal ultrasound to investigate liver steatosis. Dietary profile was assessed by 24-hour food recall (24hR), and Food Frequency Questionnaire (FFQ). Diet quality was assessed by the Healthy Eating Index (HEI) adapted for the Brazilian population. Physical activity practice was also assessed. Results 87 participants were included (average age 35.2 ± 5.7 years), among whom, 67 (77%) had NAFLD. The group with PCOS and NAFLD presented higher body mass index (BMI) (34.9 ± 4.5 vs. 30.4 ± 4.9 kg/m2; p = 0.001), Waist Circumference (WC) (103 [97‒113] vs. 95 [87.5‒100] cm; p < 0.001) and were considered physically active less frequently than those without NAFLD (34.3% vs. 60%; p = 0.04). Food intake and dietary patterns assessed by 24hR, FFQ and HEI presented no difference between the groups. Conclusions PCOS women with coexistent NAFLD had higher BMI, WC and were less physically active than those without NAFLD. Dietary evaluation showed that PCOS women with NAFLD had no significant difference in macro and micronutrients or food group intake and diet quality in comparison to those without NAFLD.

MRSA outbreak in a Neonatal Intensive Care Unit in a developed country: importance of rapid detection of reservoirs and implementation of intervention measures

ABSTRACT We described a MRSA bloodstream infection outbreak that was rapidly identified and controlled in a Neonatal Intensive Care Unit after implementation of a bundle of measures, including PCR-screening and HCW decolonization. We found 35% of healthcare workers(HCW) colonized with S. aureus by PCR, one of them that presented skin lesion positive for MSSA (same clone and spa type than two patients). Our findings raise the hypothesis that the outbreak could be related to HCW colonization.

Use and misuse of biomarkers and the role of D-dimer and C-reactive protein in the management of COVID-19: A post-hoc analysis of a prospective cohort study

OBJECTIVE: Coronavirus disease 2019 (COVID-19) is associated with high mortality among hospitalized patients and incurs high costs. Severe acute respiratory syndrome coronavirus 2 infection can trigger both inflammatory and thrombotic processes, and these complications can lead to a poorer prognosis. This study aimed to evaluate the association and temporal trends of D-dimer and C-reactive protein (CRP) levels with the incidence of venous thromboembolism (VTE), hospital mortality, and costs among inpatients with COVID-19. METHODS: Data were extracted from electronic patient records and laboratory databases. Crude and adjusted associations for age, sex, number of comorbidities, Sequential Organ Failure Assessment score at admission, and D-dimer or CRP logistic regression models were used to evaluate associations. RESULTS: Between March and June 2020, COVID-19 was documented in 3,254 inpatients. The D-dimer level ≥4,000 ng/mL fibrinogen equivalent unit (FEU) mortality odds ratio (OR) was 4.48 (adjusted OR: 1.97). The CRP level ≥220 mg/dL OR for death was 7.73 (adjusted OR: 3.93). The D-dimer level ≥4,000 ng/mL FEU VTE OR was 3.96 (adjusted OR: 3.26). The CRP level ≥220 mg/dL OR for VTE was 2.71 (adjusted OR: 1.92). All these analyses were statistically significant (p<0.001). Stratified hospital costs demonstrated a dose-response pattern. Adjusted D-dimer and CRP levels were associated with higher mortality and doubled hospital costs. In the first week, elevated D-dimer levels predicted VTE occurrence and systemic inflammatory harm, while CRP was a hospital mortality predictor. CONCLUSION: D-dimer and CRP levels were associated with higher hospital mortality and a higher incidence of VTE. D-dimer was more strongly associated with VTE, although its discriminative ability was poor, while CRP was a stronger predictor of hospital mortality. Their use outside the usual indications should not be modified and should be discouraged.

Metacontingências e Autocontrole Ético: Efeito das magnitudes das consequências individuais e culturais / Metacontingencies and Ethical Self-Control: Effect of magnitudes of individual and cultural consequences

Resumo O objetivo deste trabalho foi avaliar o efeito da manipulação das magnitudes das consequências individuais e culturais sobre o padrão de escolhas em situações de autocontrole ético e metacontingências. Seis estudantes universitários foram divididos em duas microculturas, uma com delineamento ABCAC'B'A e outra com um delineamento AC'B'ABCA. Nas condições B e B', a magnitude da consequência individual para respostas impulsivas aumentava enquanto a consequência cultural diminuía. Nas condições C e C', aumentava a magnitude da consequência cultural e diminuía a consequência individual. Os resultados indicaram a seleção de um padrão de escolhas em ambas as microculturas pela consequência cultural, com pouca ou nenhuma influência da manipulação da magnitude das consequências.

Abstract The objective of this study was to evaluate the effect of the magnitudes of the individual and cultural consequences on the pattern of choices in situations of ethical self-control and metacontingencies. Six college students were divided into two microcultures, one with ABCAC'B'A design and another with an AC'B'ABCA design. In conditions B and B' the magnitude of the individual consequence for impulsive responses increased while the cultural consequence diminished. In conditions C and C' the magnitude of the cultural consequence increased and the individual consequence diminished. The results indicated the selection of a pattern of choices by the groups of both microcultures, according to the cultural consequence, with little or no influence of the manipulation of the magnitude of the consequences.

Efeitos de um Análogo de Reforçamento Negativo sobre a Seleção de Culturantes / Effects of an Analogue of Negative Reinforcement on the Selection of Culturants

Resumo O presente estudo investigou os efeitos de um análogo de reforçamento negativo sobre a seleção de culturantes e, diferentemente de estudos anteriores, buscou eliminar a interferência da punição negativa de outros culturantes. Três microculturas de laboratório, com três participantes cada, foram expostas a um delineamento ABAB. Os participantes escolhiam entre linhas coloridas e numeradas de 1 a 10. Na condição de Reforçamento Positivo (A), os culturantes-alvo produziam consequências culturais. Na condição de Reforçamento Negativo (B), as consequências culturais eram subtraídas a cada 30s, mas os culturantes-alvo podiam adiar a perda dessas consequências. O análogo de reforçamento negativo, assim como o de reforçamento positivo, selecionou os culturantes-alvo sem a interferência de contingências punitivas acidentais.

Abstract The present research investigated the effect of a negative reinforcement analog on the selection of culturants and, unlike previous studies, sought to eliminate the interference of the negative punishment of other culturants. Three laboratory microcultures, with three participants in each of them, were exposed to an ABAB design. The participants chose between colored lines, numbered from 1 to 10. In the Positive Reinforcement condition (A), target culturants produced cultural consequences. In the Negative Reinforcement condition (B), cultural consequences were subtracted every 30 seconds, but target culturants could delay the loss of those consequences. The analog of negative reinforcement, as well as that of positive reinforcement, selected target culturants without the interference of accidental punitive contingencies.

The impact of positive airway pressure on midface growth: a literature review / O impacto da pressão positiva nas vias aéreas no crescimento da face média: uma revisão da literatura

Abstract Introduction: The treatment of obstructive sleep apnea with positive airway pressure in children is restricted due to concerns that it could affect maxilla growth over time. Objective: To undertake a systematic review of the literature about the long-term impact of using a positive airway pressure mask on the midface in growing individuals. Methods: The literature search was conducted in September 2019 using the keywords ("long-term" OR "long term" OR "side effects" OR longitudinal) AND (children OR child OR preschool OR adolescents OR adolescent OR infant OR infants) AND (craniofacial OR "mid-face" OR midface OR midfacial OR facial OR maxillary) AND ("airway pressure" OR ventilation) in the databases PubMed, Web of Science and Lilacs. The search included papers published in English, until September 2019, on the effects of positive airway pressure on midfacial growth. Results: The search strategy identified five studies: two case reports, two cross-sectional studies and one retrospective cohort study. All studies evaluated the long-term effects of a using a nasal mask on the midface in children and adolescents; four showed midface hypoplasia and one no showed difference post- treatment compared to a control. Conclusion: Most of the studies demonstrated that long-term use of nasal positive airway pressure in childhood/adolescence is associated with midface hypoplasia.

Resumo Introdução: O tratamento da apneia obstrutiva do sono com pressão positiva nas vias aéreas em crianças é restrito devido a preocupações de que possa afetar o crescimento da maxila em longo prazo. Objetivo: Realizar uma revisão sistemática da literatura sobre o impacto em longo prazo do uso de uma máscara de pressão positiva nas vias aéreas na face média em indivíduos em crescimento. Método: A pesquisa bibliográfica foi realizada em setembro de 2019 utilizando as palavras-chave (long-term OR side effects OR longitudinal) AND (children OR child OR preschool OR adolescents OR adolescent OR infant OR infants) AND (craniofacial OR mid-face OR midface OR midfacial OR facial OR maxillary) AND (airway pressure OR ventilation) nas bases de dados PubMed, Web of Science e Lilacs. A pesquisa incluiu artigos publicados em inglês, até setembro de 2019, sobre os efeitos da pressão positiva nas vias aéreas no crescimento médio-facial. Resultados: A estratégia de busca identificou cinco estudos: dois relatos de casos, dois estudos transversais e um estudo de coorte retrospectivo. Todos os estudos avaliaram os efeitos em longo prazo do uso de máscara nasal na face média em crianças e adolescentes; quatro apresentaram hipoplasia da face média e um paciente não mostrou diferença após o tratamento em comparação com um controle. Conclusão: A maioria dos estudos demonstrou que o uso prolongado da pressão positiva nas vias aéreas nasal na infância/adolescência está associado à hipoplasia da face média.

Nonalcoholic fatty liver disease in women with polycystic ovary syndrome: associated factors and noninvasive fibrosis staging in a single Brazilian center

ABSTRACT Objective Polycystic ovary syndrome (PCOS) is a recognized risk factor for nonalcoholic fatty liver disease (NAFLD). The aims of this study were to investigate the prevalence and factors associated with NAFLD in women with PCOS and evaluate noninvasive indices of hepatic fibrosis in patients with PCOS and NAFLD. Subjects and methods Patients with PCOS (n = 87) and women without PCOS (n = 40; controls) were included. NAFLD was diagnosed by abdominal ultrasonography after exclusion of alcohol consumption and viral or autoimmune liver disease. Anthropometric, clinical and metabolic variables, homeostasis model assessment of insulin resistance (HOMA-IR) index, lipid accumulation product (LAP), FIB-4 index, NAFLD score, and transient elastography (TE; FibroScan) were obtained in subsets of patients with PCOS and NAFLD. Results A total of 87 patients with PCOS were included (mean age: 34.4 ± 5.7 years, mean body mass index [BMI]: 34.7 ± 4.7 kg/m 2 ). NAFLD was present in 67 (77.0%) patients with PCOS versus 21 of 40 (52.5%) controls (p = 0.005). Women with PCOS and liver steatosis, compared with their NAFLD-free counterparts, had higher values of BMI, waist circumference, triglycerides, total cholesterol, alanine and aspartate aminotransferases, and γ-glutamyltransferase, along with higher frequencies of obesity, metabolic syndrome, and insulin resistance. NAFLD was independently associated with waist circumference, serum triglycerides, and alanine aminotransferase levels. The FIB-4 index was not compatible with advanced fibrosis in any of the evaluated patients, while NAFLD score and TE were compatible with advanced liver fibrosis in 1 of 26 (3.8%) and 3 of 25 (12%) patients, respectively. Conclusion Women with PCOS had a high risk of NAFLD, and a combination of both was associated with central obesity, dyslipidemia, insulin resistance, and metabolic syndrome. Noninvasive methods suggested low rates of severe hepatic fibrosis in Brazilian women with PCOS. Arch Endocrinol Metab. 2020;64(3):235-42

Using craniofacial characteristics to predict optimum airway pressure in obstructive sleep apnea treatment / Uso de características craniofaciais para predizer a pressão ideal nas vias aéreas notratamento da apneia obstrutiva do sono

Abstract Introduction: Manual titration is the gold standard to determinate optimal continuous positive airway pressure, and the prediction of the optimal pressure is important to avoid delays in prescribing a continuous positive airway pressure treatment. Objective: To verify whether anthropometric, polysomnographic, cephalometric, and upper airway clinical assessments can predict the optimal continuous positive airway pressure setting for obstructive sleep apnea patients. Methods: Fifty men between 25 and 65 years, with body mass indexes of less than or equal to 35 kg/m2 were selected. All patients had baseline polysomnography followed by cephalometric and otolaryngological clinical assessments. On a second night, titration polysomnography was carried out to establish the optimal pressure. Results: The average age of the patients was 43 ± 12.3 years, with a mean body mass index of 27.1 ± 3.4 kg/m2 and an apnea-hypopnea index of 17.8 ± 10.5 events per hour. Smaller mandibular length (p = 0.03), smaller atlas-jaw distance (p = 0.03), and the presence of a Mallampati III and IV (p = 0.02) were predictors for higher continuous positive airway pressure. The formula for the optimal continuous positive airway pressure was: 17.244 − (0.133 × jaw length) + (0.969 × Mallampati III and IV classification) − (0.926 × atlas-jaw distance). Conclusion: In a sample of male patients with mild-to-moderate obstructive sleep apnea, the optimal continuous positive airway pressure was predicted using the mandibular length, atlas-jaw distance and Mallampati classification.

Resumo Introdução: A titulação manual é o padrão-ouro para determinar a pressão ideal para o tratamento com a pressão positiva contínua nas vias aéreas; e a predição da pressão ideal é importante para evitar retardos na sua prescrição. Objetivo: Verificar se as avaliações clínicas antropométricas, polissonográficas, cefalométricas e das vias aéreas superiores podem predizer a configuração ideal da pressão do aparelho de pressão positiva contínua nas vias aéreas para pacientes com apneia obstrutiva do sono. Método: Foram selecionados 50 homens entre 25 e 65 anos, com índice de massa corporal menor ou igual a 35 kg/m2. Todos os pacientes fizeram polissonografia basal, seguida de avaliações clínicas cefalométricas e otorrinolaringológicas. Na segunda noite, foi feita polissonografia de titulação para estabelecer a pressão ideal. Resultados: A média de idade dos pacientes foi de 43 ± 12,3 anos, com índice de massa corporal médio de 27,1 ± 3,4 kg/m2 e índice de apneia-hipopneia de 17,8 ± 10,5 eventos por hora. Menor comprimento mandibular (p = 0,03), menor distância atlas-maxila (p = 0,03) e a presença de Mallampati III e IV (p = 0,02) foram preditores de pressão mais elevada. A fórmula para a pressão positiva contínua nas vias aéreas foi: 17,24 - (0,133 × comprimento da mandíbula) + (0,969 × classificação de Mallampati III e IV) - (0,926 × distância atlas-mandíbula). Conclusão: Em uma amostra de homens com apneia obstrutiva do sono leve a moderada, a pressão positiva contínua nas vias aéreas foi predita com o comprimento mandibular, a distância atlas-mandíbula e a classificação de Mallampati.

Efeito da entrevista motivacional no autocuidado de pessoas com insuficiência cardíaca: ensaio clínico randomizado / Efecto de la entrevista motivacional sobre el autocuidado de personas con insuficiencia cardíaca: ensayo clínico aleatorizado / Effect of motivational interviewing on self-care of people with heart failure: a randomized clinical trial

RESUMO Objetivo: Analisar o efeito da entrevista motivacional no autocuidado de pessoas com insuficiência cardíaca crônica. Método: Ensaio clínico randomizado, multicêntrico, dividindo as pessoas em grupo intervenção (n=59) e grupo controle (n=59), acompanhadas por 60 dias nos centros do Brasil e Uruguai. O grupo intervenção recebeu três consultas por entrevista motivacional, com intervalo de 30 dias, e o grupo controle manteve o acompanhamento convencional nas clínicas especializadas. Os dados foram avaliados através do Self-Care of Heart Failure Index 6.2, antes e após a intervenção, em cada um dos centros e analisados através de média, mediana, teste-t, análise de correlação pelo coeficiente de Spearman e efeito da intervenção pelo d de Cohen. Resultados: 118 pessoas concluíram o estudo. Diante da avaliação do efeito da entrevista motivacional no autocuidado, comparando-se ao acompanhamento convencional, foi identificado efeito médio na manutenção e manejo (Cohen-d=0,6723; 0,5086) e alto na confiança do autocuidado (Cohen-d=0,9877). Conclusão: A entrevista motivacional foi efetiva na melhora do autocuidado dos pacientes com insuficiência cardíaca, sendo uma estratégia factível a ser implementada em clínicas especializadas. Registro Brasileiro de Ensaios Clínicos: RBR-6fp5qt.

RESUMEN Objetivo: Analizar el efecto de las entrevistas motivacionales en el autocuidado de personas con insuficiencia cardíaca crónica. Método: Ensayo clínico aleatorizado, multicéntrico, que divide a las personas en un grupo de intervención (n=59) y un grupo de control (n=59), seguidos durante 60 días en centros de Brasil y Uruguay. El grupo de intervención recibió tres consultas por entrevista motivacional, con un intervalo de 30 días, y el grupo de control mantuvo el monitoreo convencional en clínicas especializadas. Los datos se evaluaron utilizando el Self-Care of Heart Failure Index 6.2, antes y después de la intervención, en cada uno de los centros y se analizaron utilizando la media, la mediana, la prueba t, el análisis de correlación utilizando el coeficiente de Spearman y el efecto de la intervención por el d de Cohen. Resultados: 118 personas completaron el estudio. En vista de la evaluación del efecto de la entrevista motivacional sobre el autocuidado, en comparación con el seguimiento convencional, un efecto medio en el mantenimiento y el manejo (Cohen-d=0.6723; 0.5086) y alto en la confianza en el autocuidado (Cohen-d=0,9877). Conclusión: La entrevista motivacional fue efectiva para mejorar el autocuidado de pacientes con insuficiencia cardíaca, siendo una estrategia factible para ser implementada en clínicas especializadas. Registro brasileño de ensayos clínicos: RBR-6fp5qt.

ABSTRACT Objective: To analyze the effect of motivational interviewing on self-care for people with chronic heart failure. Method: A multicenter randomized clinical trial, which divided people into an intervention group (n=59) and a control group (n=59), followed for 60 days in centers of Brazil and Uruguay. The intervention group received three consultations per motivational interviewing, with an interval of 30 days, and the control group maintained conventional follow-up in specialized clinics. The data were assessed using the Self-Care of Heart Failure Index 6.2, before and after intervention in each of the centers. They were analyzed using the mean, median, t-test, correlation analysis using the Spearman coefficient and effect of the intervention by Cohen's d. Results: One hundred and eighteen people completed the study. In view of the assessment of the effect of the motivational interviewing on self-care, compared to conventional follow-up, a medium effect on maintenance and management (Cohen's d=0.6723; 0.5086) and high on self-care confidence (Cohen's d=0.9877). Conclusion: Motivational interviewing was effective in improving self-care in patients with heart failure, being a feasible strategy to be implemented in specialized clinics. Brazilian Registry of Clinical Trials (Registro Brasileiro de Ensaios Clínicos): RBR-6fp5qt.

Approach to endoscopic procedures: a routine protocol from a quaternary university referral center exclusively for coronavirus disease 2019 patients

OBJECTIVES: The present coronavirus disease (COVID-19) pandemic has ushered in an unprecedented era of quality control that has necessitated advanced safety precautions and the need to ensure the adequate protection of healthcare professionals (HCPs). Endoscopy units, endoscopists, and other HCP may be at a significant risk for transmission of the virus. Given the immense burden on the healthcare system and surge in the number of patients with COVID-19, well-designed protocols and recommendations are needed. We aimed to systematically characterize our approach to endoscopic procedures in a quaternary university hospital setting and provide summary protocol recommendations. METHOD: This descriptive study details a COVID-19-specific protocol designed to minimize infection risks to patients and healthcare workers in the endoscopy unit. RESULTS: Our institution, located in São Paulo, Brazil, includes a 900-bed hospital, with a 200-bed-specific intensive care unit exclusively designed for patients with moderate and severe COVID-19. We highlighted recommendations for infection prevention and control during endoscopic procedures, including appropriate triage and screening, outpatient management and procedural recommendations, role and usage of personal protective equipment (PPE), and role and procedural logistics involving COVID-19-positive patients. We also detailed hospital protocols for reprocessing endoscopes and cleaning rooms and also provided recommendations to minimize severe acute respiratory syndrome coronavirus 2 transmission. CONCLUSION: This COVID-19-specific administrative and clinical protocol can be replicated or adapted in multiple institutions and endoscopy units worldwide. Furthermore, the recommendations and summary protocol may improve patient and HCP safety in these trying times.

The Influence of the Type of Surgical Thread and Suture in the Open Carpal Tunnel Syndrome Surgery

Carpal tunnel syndrome (CTS) is the result of compression and/or traction of the median nerve in the carpal tunnel. It is the most frequent compressive neuropathy of the upper limbs and it is usually idiopathic. Diagnosis is essentially clinical, defined by symptoms and provocative tests. Decompression of themedian nerve by section of the transverse carpus ligament is the treatment of choice, but the lack of consensus on the type of suture and surgical thread to be used in the open carpal tunnel decompression surgery justifies the importance of evaluating the comparative results of existing studies, aiming to describe the influence of different types of sutures and surgical threads to guide the professionals about the most appropriate conduct. This is a systematic review of the international and national literature. Four studies comparing the influence of surgical threads and one study evaluating the influence of the type of suture were found. From the comparative studies, it was observed that there is advantage in the use of nonabsorbable suture due to the lower occurrence of inflammation and postoperative wound complications. When using Donatti sutures, wound edge inversion is less likely to occur comparedwith single individual sutures, but they are also related to longer postoperative pain.

Avaliação das linhas B pulmonares utilizando ultrassonografia à beira leito por diferentes médicas intensivistas: um estudo de confiabilidade / Evaluation of pulmonary B lines by different intensive care physicians using bedside ultrasonography: a reliability study

RESUMO Objetivo: Avaliar a concordância entre médicos intensivistas que receberam treinamento semelhante para utilização do ultrassom pulmonar à beira do leito, na identificação das linhas B pulmonares visualizadas em tempo real, a fim de verificar a reprodutibilidade do método. Métodos: Foram analisados 67 pacientes que apresentaram alguma piora ventilatória identificada nas últimas 12 horas da realização do ultrassom pulmonar, no período de novembro de 2016 a março de 2017, estando todos internados em um centro de terapia intensiva de um hospital privado de Belo Horizonte (MG). Os ultrassons pulmonares foram realizados por três profissionais diferentes, denominados A, B e C, sendo o intervalo de tempo entre cada ultrassom pulmonar menor que 3 horas. As zonas torácicas visualizadas foram apenas as anteriores e laterais, sendo definidas como zonas anteriores (1) direita e esquerda (Z1D e Z1E, respectivamente), delimitadas pela clavícula, esterno, linha horizontal perpendicular ao processo xifoide e linha axilar anterior; e zonas laterais (2) direita e esquerda (Z2D e Z2E, respectivamente), abrangendo a área entre linha axilar anterior e posterior lateralmente, tendo como limite inferior a mesma linha horizontal correspondente à altura do processo xifoide. Uma zona pulmonar era considerada positiva para linhas B, quando houvesse visualização de três ou mais dessas linhas, caracterizando possível síndrome interstício-alveolar. Por meio do valor Kappa, avaliamos a concordância dentre as quatro zonas, conforme execução de cada dupla de profissional (AB, AC e BC). Resultados: Cerca de 80% das áreas visualizadas tiveram concordância classificada como moderada a substancial, com Kappa variando de 0,41 - 079 (p < 0,05; IC95%). Os maiores graus de concordância ocorreram nas zonas superiores Z1D e Z1E entre os subgrupos AC e BC, com Kappa em torno de 0,65 (p < 0,001). Já a Z2E apresentou uma das menores concordâncias, com Kappa de 0,36. Conclusão: A possível limitação do ultrassom pulmonar quanto ao efeito examinador-dependente não se mostrou presente neste trabalho, sugerindo boa reprodutibilidade dessa modalidade diagnóstica à beira do leito.

ABSTRACT Objective: To evaluate the agreement between intensive care physicians with similar training in the use of bedside lung ultrasonography in identifying pulmonary B lines, visualized in real time, to verify the reproducibility of the method. Methods: A total of 67 patients with some ventilatory deterioration identified within 12 hours after a pulmonary ultrasonography in the period from November 2016 to March 2017 were analyzed, and all were admitted to an intensive care unit of a private hospital in Belo Horizonte, Minas Gerais. The lung ultrasonographies were performed by three different professionals, termed A, B and C, and the time interval between each lung ultrasonography was less than 3 hours. The only visualized chest zones were the anterior and lateral, defined as right and left anterior (1) zones (Z1R and Z1L, respectively), which were delimited by the clavicle, the sternum and the horizontal line perpendicular to the xiphoid process and anterior axillary line. The right and left lateral (2) zones (Z2R and Z2L, respectively) covered the lateral area between the anterior and posterior axillary lines, with the lower limit being the same horizontal line corresponding to the height of the xiphoid process. A lung zone was considered positive for B lines upon visualization of three or more of these lines, suggesting the presence of alveolar-interstitial syndrome. Using the Kappa value, we evaluated the agreement among the four zones according to the execution of each pair of professionals (AB, AC and BC). Results: Approximately 80% of the areas that were visualized showed a moderate to substantial agreement, with the Kappa values ranging from 0.41 - 079 (p < 0.05; 95% CI). The highest levels of agreement occurred in the upper zones Z1R and Z1L between subgroups AC and BC, with a Kappa of approximately 0.65 (p < 0.001). In turn, Z2L showed one of the lowest agreements, with a Kappa of 0.36. Conclusion: The possible limitation of an examiner-dependent effect on lung ultrasounds was not found in this study, suggesting the good reproducibility of this diagnostic modality at the bedside.

Idade como fator de risco para diabetes mellitus gestacional / Age as a risk factor for gestational diabetes mellitus

Objective:To investigate the age cutoff point for the detection of gestational diabetes mellitus (GDM). Method:Case-control study with 416 pregnant women served at a prenatal outpatient clinic of a maternity hospital in Rio de Janeiro, RJ, Brazil. The analysisof the receiver operating characteristic curve was performed with the data to determine values with sensitivity optimization according to the specificity. Results:It is estimated that the odds ratio in a woman aged ≥25 years for developing gestational diabetes mellitus is 2.3 times higher. The age ≥22.5 years was determined as a point that maximizes the chance of developing gestational diabetes mellitus. The chance of finding this disease in a woman aged 22.5 years or older is three times greater than in younger women. Conclusion:The age cutoff point that suggests the need for greater glycemic monitoring in pregnant women was 22.5 years.

Objetivo:Investigar o ponto de corte da idade para detecção de diabetes mellitus gestacional (DMG). Método:Estudo caso-controle com 416 gestantes acompanhadas no ambulatório de pré-natal de uma maternidade no Rio de Janeiro, RJ, Brasil. A análise da curva receiver operating characteristicfoi aplicada aos dados para evidenciar valores com otimização da sensibilidade em função da especificidade. Resultados:Estima-se que a razão de chance de uma mulher com idade ≥25 anos desenvolver diabetes mellitus gestacional é 2,3 vezes maior. A idade ≥22,5 anos foi identificada como ponto que maximiza a chance para a diabetes mellitus gestacional. A chance de uma mulher com idade maior ou igual a 22,5 anos apresentar esta doença é 3,0 vezes maior do que em outra mulher com idade menor. Conclusão:O ponto de corte de idade que sugere necessidade de maior monitoramento de glicemia em gestantes é de 22,5 anos.

23. Consulta por teléfono a pacientes con insuficiencia cardiáca crónica

Antecedentes: la consulta por teléfono puede ser considerada un método importante incorporado a la consulta tradicional de pacientes con insuficiencia cardíaca, ya que tiene por objetivo reevaluar, reforzar o reorientar cuestiones acerca del manejo de la enfermedad. Objetivo: evaluar la adhesión al tratamiento, autocuidado y calidad de vida, antes y después de la consulta de enfermería por teléfono en pacientes con insuficiencia cardíaca crónica bajo seguimiento en una clínica especializada. Material y método: estudio casi experimental, con 14 pacientes de una clínica especializada en tratamiento de insuficiencia cardíaca de Niterói. Los puntajes de adhesión al tratamiento, autocuidado (mantenimiento, manejo y confianza) y calidad de vida fueron evaluados por medio de cuestionarios validados antes y después de la intervención telefónica. Resultados: de los 14 pacientes, 9 (64,3%) eran del sexo masculino, 11 (78,6%) casados/unidos, con edad media de 64,8 ± 8,7 años, e ingresos de R $ 936,00 y tiempo de escolaridad de cinco años, 7 (50%) jubilados. Etiología hipertensiva, siendo las causas de morbilidad más frecuentes: la hipertensión arterial 13 (92,9%), y el infarto agudo de miocardio (35,7%). Se observó un avance con relación con la adhesión al tratamiento (p <0,0001), en el mantenimiento (p = 0,002), manejo (p <0,0001) y en la confianza del autocuidado (p = 0,004). No hubo diferencia estadística significativa en la calidad de vida. Conclusiones: la mejora de las habilidades para el autocuidado y la adhesión después de la consulta telefónica de enfermería muestran que esta intervención puede traer resultados clínicos benéficos. Registro Brasileño de Ensayos Clínicos (ReBEC) sob nº RBR-6P9FJG.

Redução de vulnerabilidades associadas ao consumo de SPA: ferramentas para compreensão e ação / Reduction SPA consumption vulnerabilities: tools for understanding and action

Apresentamos a comunidade mais uma produção acadêmico-científica, resultado da experiência e de estudos do nosso coletivo piauiense, CRR-UFPI, e de outros autores renomados no campo dos psicoativos. Esta publicação reúne as principais abordagens, estratégias, equipamentos e intervenções na atenção às pessoas vulnerabilizadas pelo consumo de SPA. Mobilizamos parceiros na perspectiva de articular saberes e ações conjuntas em prol dos direitos da pessoa com transtorno mental, sobretudo dos consumidores de substâncias psicoativas, na direção de sua protagonização/empoderamento e assim, vocalização de suas necessidades por si mesmo, ampliando espaços de diálogo, negociação e visibilidade de outras identidades e vulnerabilidades, ampliando e complexificando um novo olhar e as intervenções sobre a temática. (AU).

Predictors of success for mandibular repositioning appliance in obstructive sleep apnea syndrome

Abstract The characteristics of non-obese patients with mild to moderate Obstructive Sleep Apnea Syndrome (OSAS) who will present with a good response to Mandibular Repositioning Appliance (MRA) treatment have not yet been well established in the literature. The aim of this study is to assess whether polysomnographic (PSG), demographic, anthropometric, cephalometric, and otorhinolaryngological parameters predict MRA success in the treatment of OSAS. Forty (40) males with mild and moderate OSAS were assessed pretreatment and 2-months post-treatment after wearing an MRA. Demographic, anthropometric, otorhinolaryngological (ENT), cephalometric, and polysomnographic parameters, including continuous positive airway pressure (CPAP) titrated pressure, dental models, Epworth Sleepiness Scale, quality of life (Short Form SF-36), and mood state (Profile of Mood States – POMS), were assessed. The responders exhibited fewer oropharyngeal alterations, increased upper pharyngeal space, reduced lower airway space, and increased mandibular intercanine width, and they had milder disease. Nevertheless, no predictive factors of MRA success could be found. MRA was more successful among men with a more pervious airway, a larger interdental width and milder OSAS. However, a combined [1] functional and structural assessment is needed to successfully predict the [2] effectiveness of MRA treatment of OSA.

Avaliação da função de sensibilidade ao contraste em diferentes faixas etárias nas médias e altas frequências espaciais / Contrast sensitivity assessment in different age group in medium and high spatial frequency

RESUMO Objetivo: Comparar a sensibilidade ao contraste nas faixas etárias de 20 a 25, 40 a 45 e acima de 60 anos de idade. Métodos: Realizou-se um estudo transversal com indivíduos de diferentes idades, com acuidade visual superior a 20/25, sem doença ocular e sem cirurgia oftalmológica prévia. A acuidade visual foi medida pelo teste de Snellen e, a sensibilidade ao contraste, pelo aparelho OPTEC 3500P(r). A análise estatística foi realizada pelo teste de Wilcoxon, considerando um intervalo de confiança de 95%. Resultados: Em relação aos pacientes de 20 a 25 anos, os de 40 a 45 anos não apresentaram diminuição significativa da sensibilidade ao contraste em nenhuma das frequências espaciais avaliadas. Comparando os pacientes acima de 60 anos aos de 40 a 45 anos, houve diminuição da sensibilidade ao contraste nas frequências de 6,0 a 18,0 cpg no modo diurno e de 3,0 a 18,0 cpg no noturno. Já quando comparados aos de 20 a 25 anos, os pacientes maiores de 60 anos mostraram diminuição nas frequências de 3,0 a 18 cpg no modo diurno e em todas as frequências no modo noturno. Conclusão: A função de sensibilidade ao contraste parece diminuir com a idade, após os 45 anos, principalmente nas médias e altas frequências espaciais. Isso pode impactar na leitura, na direção e na mobilidade, dentre outras atividades diárias.

ABSTRACT Objective: To compare contrast sensitivity in different age groups: 20 to 25, 40 to 45 and above 60 years old. Methods: We performed a cross sectional study with individuals of different ages, with visual acuity better than 20/25, without eye disease and without prior eye surgery. Visual acuity was measured by Snellen test and contrast sensitivity was evaluated by OPTEC 3500P(r) equipment. Statistical analysis was performed using Wilcoxon test, considering a 95% confidence interval. Results: Compared to patients between 20 and 25 years old, patients between 40 and 45 years old did not presented decreased contrast sensitivity in any of evaluated frequencies. When compared to patients between 40 and 45 years old, patients over 60 years old presented decrease in contrast sensitivity at frequencies of 6,0 to 12,0 cpg in diurnal mode and 3,0 to 18,0 cpg in nocturnal mode. But when compared to patients between 20 and 25 years, patients older than 60 years old showed contrast sensitivity decreased in the frequencies of 3,0 to 18 cpg in diurnal mode and at all frequencies in nocturnal mode. Conclusion: Contrast sensitivity seems to decrease with age, after 45 years old, especially in middle and high spatial frequencies. This condition may affect reading, direction and mobility, as well as other daily activities.

Experiências de cuidados intersetoriais aos consumidores de substâncias psicoativas no Piauí / Experiences of intersectoral care for psychoactive substance users in Piauí

Este livro condensa mais um dos produtos da 2ª edição da implementação das ações do plano de trabalho do Centro Regional de Referência em Formação Permanente aos Profissionais que atuam nas Redes de Atenção Integral à Saúde e de Assistência Social com Usuários de Crack e Outras Drogas do Piauí - CRR-UFPI 2ª ed., a partir do Edital nº 08/2014, lançado pela Secretaria Nacional de Políticas sobre Drogas - SENAD. (AU).